Therapist empathy is one of the common factors of psychotherapy that is important to all types of therapy. It is one of the most studied factors in psychotherapy, largely because of its relationship to patient outcomes. In one meta-analysis, therapist empathy, as rated by patients, was significantly correlated with reduced client symptoms (r = .28). Therapist empathy likely promotes metacognition, emotion regulation, and a corrective emotional experience for clients. Therapist empathy has several key components. One is affective empathy, or having a shared emotional state with the client. Affective empathy includes empathic concern but may also include therapists’ experience of personal distress during empathic experiences. A second component is cognitive empathy, or the ability to take the client's perspective. Cognitive empathy includes perspective-taking and the use of fantasy or imagination. Depending on their dispositions, some therapists likely engage in or experience different forms of empathy when working with clients. In this study, Lachance and colleagues had 376 psychotherapists of varying theoretical orientations, ages, and experience levels complete questionnaires about their level and type of empathy. The authors were also interested in whether therapist personality characteristics, attachment style, and narcissism were associated with the quality and amount of empathy. They used a statistical approach (latent class analysis) to categorize therapists into different dispositions or profiles regarding empathy. The researchers were able to categorize therapists into 4 types or profiles. First, the Rational Empathic profile represented 20% of therapists. These therapists tended to have high levels of empathic concern with their clients and adopted their clients' perspectives to understand them better. Second, the Disengaged/Detached profile represented 10% of therapists. These therapists had low levels of all subtypes of empathy, revealing a deficit in an empathic disposition. Third, the Empathic Immersion profile represented 35% of the psychotherapists who had high levels of empathic concern, followed by perspective-taking and using fantasy or imagination. Fourth, the Insecure/Self Absorbed profile represented 35% of psychotherapists. These therapists had high levels of personal distress related to empathic experiences and low levels of emphatic concern and perspective-taking. The authors also looked at the personality characteristics of each of these four profiles of therapists. Therapists in the Rational Empathic profile had a stronger sense of emotional stability and secure attachment. Therapists in the Disengaged/Detached profile had high levels of attachment avoidance and conscientiousness. Therapists who belonged to the Insecure/Self-Absorbed and the Empathic Immersion profiles had higher vulnerable narcissistic traits.
Practice Implications
The Rational Empathic (cognitive empathy) and Empathic Immersion (affective empathy) profiles suggest that 55% of therapists have strong and different empathic dispositions. However, 45% of therapists in the Disengaged/Detached and Insecure/Self Absorbed profiles are characterized by lower levels of empathy. This suggests that almost one in two therapists report some form of dysfunction with regard to empathy. Given the established relationship between therapist empathy and client outcomes, psychotherapy training programs should include more personal development to nurture a capacity for empathy among its trainees.
Lachance, V., Laverdiere, O., Kealy, D., Ogrodniczuk, J.S. (2024). Dispositional empathy among psychotherapists: A latent profile analysis. Clinical Psychology & Psychotherapy, 31, E3016. https://doi.org/10.1002/cpp.3016
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